Asthma is a common, severe, and debilitating general medical condition. Data suggest that the prevalence of asthma and asthma-related morbidity and mortality are increasing in the United States particularly in minority, inner-city, and low socioeconomic status populations. These populations, which are traditionally underrepresented by medical research, have experienced a relative epidemic of asthma during the past decade, for reasons that are poorly understood. Data suggest depressive symptoms are common in asthma patients, and may even be a risk factor for death from asthma. We have initiated a research program on the interactions between asthma and clinical depression in a primarily low income, minority community served by a county-operated asthma clinic. Pilot data from this project reveal high rates of both depressive symptoms and current major depressive disorder which are generally unrecognized and untreated. We found a strong association between severity of depressive symptoms and measures of mental and physical disability in this population. Literature on patients with other general medical conditions suggest that antidepressant therapy is frequently associated with improvement in mood, medical symptoms, and functioning. However, no controlled trials of antidepressants have been reported in depressed asthma patients. This is an important population in which to examine the effects of antidepressant therapy as (1) asthma prevalence and deaths are increasing, (2) depression is common and has been suggested as a risk factor for mortality in this population, and (3) asthma has traditionally been considered an illness in which mood may contribute to symptom exacerbations. We propose a randomized, double blind, placebo-controlled, 12-week acute phase trial of citalopram in a group of primarily low income and minority adult asthma outpatients with nonpsychotic major depressive disorder. Symptoms of depression and asthma will be the primary outcome measures. This project will be a pilot study to determine effect size for the outcome measures. If the results of this study suggest improvement in depression and/or asthma symptoms following antidepressant therapy, we anticipate a larger and longer antidepressant trial examining mood and asthma symptoms, as well as utilization of medical services in patients receiving active drug versus placebo.